There are concerns regarding postoperative infections following laparoscopic colectomy with intracorporeal anastomosis. Thus, in this study, we aimed to determine the optimal preoperative bowel preparation to reduce postoperative infectious complications in patients undergoing laparoscopic colectomy with intracorporeal anastomosis. This secondary analysis of the ICAN study—a multicenter, retrospective cohort study involving 46 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery—included 615 patients with colon adenocarcinoma undergoing laparoscopic colectomy with intracorporeal anastomosis between January 2020 and December 2021. Patients were analyzed after applying eligibility criteria and propensity score matching based on age ≥ 65 years, sex, body mass index ≥ 30, American Society of Anesthesiologists Physical Status, diabetes, and the number of intracorporeal anastomosis cases previously performed at the institution. Among them, 312 received combined oral antibiotics and mechanical bowel preparation, whereas 156 received other preparations (mechanical preparation alone, oral antibiotics alone, and no preparation). The primary outcome was surgical wound infection incidence (Clavien–Dindo grade ≥ II) at initial discharge. Secondary outcomes included intraperitoneal infections, anastomotic leakage, ileus, and postoperative hospital stay. Surgical wound infection (1/312 [0.3
Mid-pregnancy cervical length (CL) has limited predictive performance for spontaneous preterm birth (sPTB) in the normal range. The uterocervical angle (UCA) is a promising marker, but evidence regarding late-pregnancy UCA and its longitudinal change is limited. We evaluated UCA in mid- and late-pregnancy and the
Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
LBA8518 Background: Among common EGFR-mutant NSCLC, L858R mutation is suggested to be less sensitive to EGFR-TKIs and associated with poorer prognosis than ex 19 del. REVOL858R is the first randomized phase III trial conducted exclusively in patients with advanced/recurrent EGFR L858R–mutant NSCLC, comparing a treatment strategy of erlotinib plus ramucirumab (E+RAM) followed by osimertinib (OSI) upon detection of acquired T790M with first-line OSI monotherapy. Methods: Eligible patients were treatment-naive adults (≥20 years) with advanced/recurrent EGFR L858R–positive NSCLC and ECOG PS 0–1. Patients were randomized 1:1, stratified by clinical stage (IIIB/IIIC/IV vs postoperative recurrence), sex, and baseline brain metastasis (BM). Patients received OSI 80 mg once daily (Arm A) or E+RAM (E 150 mg once daily plus RAM 10 mg/kg every 2 weeks; Arm B). In Arm B, tumor rebiopsy or liquid biopsy at termination of E+RAM was mandated; patients with detected T790M subsequently received OSI, whereas those without T790M discontinued protocol treatment. The primary endpoint, time to failure of strategy (TFS), was defined as time from randomization to disease progression or death during OSI, or during the primary treatment when OSI was not administered (in Arm B). Results: Overall, 232 patients were randomized (Arm A n=116; Arm B n=116). Baseline characteristics were generally well balanced between the two arms. In the full analysis set, median TFS was 14.8 months in Arm A and 16.6 months in Arm B (HR 1.03; 95% CI 0.78–1.38; log-rank p=0.49). Key secondary endpoints and selected prespecified subgroup analyses of TFS are summarized in Table. The most common AEs (any grade) were diarrhea (41% vs 54%) and acneiform rash (30% vs 71%) in Arm A vs Arm B. Hypertension and proteinuria were observed in 39% and 18% of patients in Arm B, respectively. Interstitial lung disease occurred in 12 patients (10%) in Arm A, and 2 patients (2%) in Arm B. AEs leading to discontinuation of protocol treatment occurred in 21% vs 36% of patients (Arm A vs Arm B). Conclusions: A planned E+RAM-to-OSI strategy did not improve TFS compared with upfront OSI in EGFR L858R–mutated NSCLC. Safety findings were consistent with known profiles, with higher discontinuation for tolerability in the strategy arm. Trial information: jRCTs051200142. Clinical trial information: 051200142. Key secondary endpoints. Key secondary endpoint, median (months) Arm A (OSI) Arm B (E+RAM) HR (95% CI) OS 44.0 (31.1-NR) 38.4 (33.3-NR) 0.98 (0.66-1.45) 3-y OS (%) 56.1% 57.2% – ORR (%) 73.2% 66.3% – PFS1 14.8 14.9 1.08 (0.81-1.44) PFS2 23.8 25.1 0.96 (0.70-1.33) Time to treatment failure 12.6 11.2 1.34 (1.02-1.77) Key prespecified TFS subgroups <65 years / ≥65 years 18.4 / 14.8 21.2 / 16.0 0.90 (0.40-1.99) / 1.06 (0.78-1.45) With / Without baseline BM 11.8 / 19.2 14.7 / 17.8 0.81 (0.49-1.34) / 1.11 (0.79-1.57)
